高蛋白肠内营养制剂对急性脑卒中合并2型糖尿病患者的血糖影响

Effects of high-protein enteral nutritional preparation on blood glucose levels in acute stroke patients with type 2 diabetes

目的探究添加乳清蛋白粉的糖尿病型肠内营养制剂对急性脑卒中合并2型糖尿病患者血糖的影响。方法选取2020年1月至2021年5月入院的急性脑卒中合并2型糖尿病患者56例,随机分组并完成试验后为对照组28例与试验组24例,于入院后24~48 h内启动肠内营养治疗。对照组给予糖尿病适用型肠内营养制剂,试验组在此基础上添加乳清蛋白粉(15 g/500 ml营养液)。比较两组患者干预前后的空腹血糖、餐后2 h血糖(2 hours postprandial blood glucose,2h-PBG)、白蛋白、淋巴细胞计数、胰岛素使用情况、低血糖发生率及血糖最大波动幅度等指标。结果与对照组相比,试验组第7天的2h-PBG[9.85(5.9)mmol/L比12.95(2.2)mmol/L,P=0.049]、第15天的空腹血糖[(9.71±1.94)mmol/L比(11.01±2.19)mmol/L,P=0.029]和2h-PBG[(10.75±2.16)mmol/L比(12.23±2.21)mmol/L,P=0.019]显著降低;白蛋白[(34.93±4.37)g/L比(30.11±5.97)g/L,P=0.002]、淋巴细胞计数[(1.12±0.50)×10^(9)/L比(0.86±0.29)×10^(9)/L,P=0.025]显著提高;胰岛素使用天数[2.5(6)天比9(11)天,P<0.01]、胰岛素用量[0.06(0.17)U/(kg·d)比0.19(0.17)U/(kg·d),P=0.002]显著减少,血糖最大波动幅度[6.0(2.1)mmol/L比8.4(6.6)mmol/L,P=0.003]明显减小。结论提高糖尿病适用型肠内营养制剂中蛋白质的供能比例,能促进血清白蛋白的恢复,有利于急性脑卒中合并糖尿病患者的血糖控制,但其内在机制以及对远期预后的影响还需要进一步的研究探讨。

Objective To explore the effects of diabetic enteral nutrition preparation with whey protein addition on blood glucose levels in acute stroke patients with type 2 diabetes mellitus(T2DM).Methods A total of fifty-six acute stroke patients with T2DM were enrolled in this study from January 2020 to May 2021.These patients were randomly divided into the experimental group or the control group.Enteral nutrition were initiated within 24~48 hours after admission.Both groups were given diabetic enteral nutritional preparation while whey protein power was added at 15 g per 500 ml nutrient solution only in the experimental group.Fasting plasma glucose(FPG),2 hour postprandial blood glucose(2h-PBG),serum albumin,lymphocyte counts,insulin dose,hypoglycemia incidence and the maximal fluctuation of blood glucose were compared between groups before and after intervention.Results Compared with the control group,2h-PBG[9.85(5.9)mmol/L vs 12.95(2.2)mmol/L,P=0.049]on Day 7,FPG[(9.71±1.94)mmol/L vs(11.01±2.19)mmol/L,P=0.029]and 2h-PBG[(10.75±2.16)mmol/L vs(12.23±2.21)mmol/L,P=0.019]on Day 15 in experimental group were significantly decreased.The levels of serum albumin[(34.93±4.37)g/L vs(30.11±5.97)g/L,P=0.002]and lymphocyte counts[(1.12±0.50)×10^(9)/L vs(0.86±0.29)×10^(9)/L,P=0.025]in experimental group were increased significantly.While Insulin usage[2.5(6)d vs 9(11)d,P<0.001]and dose[0.06(0.17)U/(kg·d)vs 0.19(0.17)U/(kg·d),P=0.002]as well as maximal fluctuation of blood glucose[6.0(2.1)mmol/L vs 8.4(6.6)mmol/L,P=0.003]were significantly lower.Conclusion Increasing the proportion of protein in diabetic enteral nutrition can improve serum albumin level and is beneficial to blood glucose control in acute stroke patients with T2DM,but the underlying mechanisms and effects on long-term prognosis need further exploration.